Thread by @TravisABenson

I want to take a moment to attempt to dispel another case of bad science that is leveraged against the trans community by TERFs, ROGD parent groups, and some physicians that gender dysphoria naturally resolves in 85% of children #MedTwitter #LGBTQHealth #TransHealth 1/

At face value, this sounds like a scary statistic. I mean, if 85% of all children who experience gender dysphoria naturally resolve their feelings without medical or surgical interventions, it would seem like we are unnecessarily harming children. 2/

This statistic is used to support the idea of rapid-onset gender dysphoria (ROGD) and "desistance" - the narrative that children realize that they are trans by virtue of social pressures and come to realize that they have made a mistake, often when it is "too late." 3/

You might notice people on Twitter who support this theory. While some are outspoken, many still use hate-group dog-whistles such as the checkered flag or lizard emojis, use of the term "gender critical," or referring to themselves as an "adult human female." 4/

So naturally, I wanted to understand how this number of 85% came to be, since it is a major talking point for these groups. I first came across this in the Endocrine Society Guidelines. 5/ ncbi.nlm.nih.gov/pubmed/28945902

This statement is often used to argue against the use of GnRH agonists (e.g. Histrelin) as a means of delaying puberty in children. Opponents often argue that delay of puberty has irreversible negative effects on children. 6/

However, this isn't really the case. The safety of Histrelin use is well-documented in children with precocious puberty, which can be viewed as an analogous demographic. Children may be on Histrelin for upwards of 6 years to delay the effects of puberty following its onset. 7/

One study found that "Continuous histrelin implant therapy leads to safe and effective suppression of the HPG axis." But what about if they change their mind? After all, this allegedly happens to 85% of children... 8/ ncbi.nlm.nih.gov/pubmed/25803268

The study also found that "within 6 months of cessation of the histrelin implant therapy, LH and FSH levels increased to pubertal levels, indicating the ability of the HPG axis to recover after long-term gonadotropin suppression." Essentially, it is like nothing happened. 9/

So if we accept the 85% figure at face value, Histrelin therapy would be the ideal choice, as it provides children a means of delaying the irreversible effects of puberty while allowing them to still undergo puberty should they change their mind. Win-win, right? 10/

However, this shouldn't even really be a concern. The finding said that it resolves in 85% PRIOR to adolescence. Based on the WPATH Standards of Care, there are four criteria that need to be met prior to receiving Histrelin, one of which negates this entire argument: 11/

"Gender dysphoria emerged or worsened with the onset of puberty." Yup, the SOC states that there must be the onset of puberty before Histrelin can be prescribed. So, if 85% of cases of GD naturally resolve, it would have happened by this point. wpath.org/publications/s… 12/

Ok, so this entire argument set forth by those who oppose medical transitioning is moot. But I am still curious where this figure came from. I mean, for the Endocrine Society to cite it in their guidelines, it must be legit, right? I look to their source. 13/

I come across this article. However, it is a review article and the value comes from a different paper from the same author. @TheEndoSociety couldn't be bothered to even cite the primary literature. 14/ academia.edu/download/41688…

I track this figure down to this article. They report that "feelings of gender dysphoria persisted into adolescence in only 39 out of 246 of the children (15.8%) who were investigated in a number of prospective follow-up studies" ncbi.nlm.nih.gov/pubmed/21216800 15/

However, this article was a qualitative study with an N=25, not a meta-analysis, so this value that they came up with was just some ad hoc calculation based on the the following papers reported 16/

So to be clear, the authors of this article just took the crude numbers of reported "desisters" from qualitative studies ranging from 1968 to 2008 and just did some back-of-the-envelope calculations. Ok, but why should this matter? 17/

Well aside from having any scientific or statistical accountability, let's examine why lumping these studies together to create this calculation is problematic. First, the disparity in the dates of the articles. Why should this matter? 18/

Well, first of all, the article uses the term "gender dysphoria." This term was first added to the DSM in 2013, 5 years after the most recent article they cite. This is problematic because it makes any consistency between articles impossible. Without a consensus on diagnostic 19/

criteria, how are we to say anything about "desistance" across these articles? The views of gender identity vary so greatly between them. Let's take the Bawkins article, "Deviant Gender-Role Behavior in Children: Relation to Homosexuality" pediatrics.aappublications.org/content/41/3/6… 20/

Bawkins' findings state that there is "a high risk of homosexuality in children with deviant gender-role behavior, that is, effeminate or sissy boys and tomboyish girls." Language aside, this article didn't even look at "desistance" in children with GD as an outcome. 21/

There are many other examples such as this, but I don't want to tweet more than I have to. I think this makes it clear why the arguments used by "ROGD," TERF, and "desistance" communities are not scientifically sound. There is another takeaway from all of this... 22/

It's ok if someone who experiences GD changes their mind about their gender identity. No one in medicine is arguing that this is a linear process. Stop stigmatizing "desistance" as if it is the worst thing that could happen to someone. 23/

Our role as medical professionals is to assist our patients on this journey by providing a patient-centered and gender-affirming approach. Not further stigmatize them or withhold care due to paternalistic views of gender. 24/

Furthermore, I call on @TheEndoSociety to address this issue with their guidelines. They have unwittingly been giving legitimacy to a pseudoscientific statistic that has been appropriated and misused by hate groups. Please remedy this concern. 25/25

@TheEndoSociety I'd also like to know if things like this are useful to #MedTwitter. It feels kind of niche but I think it's important for all medical professionals to understand.